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Hyerim Park
, Joon-Yong Jung∗,
, Joon-Yong Jung∗,
Abstract
MRI is a valuable imaging technique for the evaluation of intraarticular diseases. Accurate inter-pretation of joint MRI necessitates sound knowledge of anatomy. In the field of joint anatomy, in addition to the discovery of new structures, previously reported joint components of unex-plained function are also detected. In this review, joint anatomy researched actively over the last decade is discussed. Joint components including the rotator cable and the superior capsule of the shoulder, posterolateral corner and the anterolateral ligament complex of the knee, and the distal tibiofibular syndesmosis of the ankle joint are introduced and correlated with their MRI features.
Index terms
Anatomy, Knee, Shoulder, Ankle, Magnetic Resonance ImagingREFERENCES
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Fig. 1.
Illustration demonstrating the normal anatomy of the posterolateral corner. A. Origins and insertion of posterolateral corner components. The LCL attaches centrally on the fibular head and is surrounded by the LBFT footprint. The AL and FFL attach to the fibular styloid process posteriorly and the PFL attaches medial to the attachment of the AL and FFL (left image). On the lateral surface of the lateral femoral condyle, the LCL originates posterior to the lateral femoral epicondyle (arrow) and anterior to the lateral head of gastrocnemius tendon (LG). Whereas the PT originates inferior and slightly anterior to the lateral epicondyle (right image). B. Courses of posterolateral corner components. The ‘P’ begins at the lateral surface of the lateral femoral condyle and passes deep to the LCL and the BF. Subsequently, the popliteus tendon passes under the mAL and lAL, and the FFL. The PFL is attached to the myotendinous junction of popliteus tendon and anchors it onto the tip of the fibular styloid process. The ILGA passes between the AL and the FFL and is a land-mark used to distinguish between them.
AL = arcuate ligament, BF = biceps femoris tendon, FFL = fabellofibular ligament, lAL = lateral limbs of the arcuate ligaments, ILGA = inferior lateral genicular artery, LBFT = long head of biceps femoris tendon, LCL = lateral collateral ligament, LG = lateral head of gastrocnemius tendon, mAL = medial, P = popliteus tendon, PFL = popliteofibular ligament, PT = popliteus tendon
Fig. 2.
Lateral collateral ligament. A. Coronal fat-suppressed intermediate-weighted image shows the entire course of the lateral collateral ligament (arrows) starting from the lateral femoral condyle to the fibular head. The intraarticular portion of the popliteus tendon (open arrow) located inner to lateral collateral ligament is also seen. B. Sagittal T2-weighted image of the lateral aspect of fibular head shows the lateral collateral ligament (arrows) and the biceps femoris tendon (arrowheads) which insert on the fibular head.
Fig. 3.
Popliteofibular ligament and popliteomeniscal fascicle. A, B. Coronal fat-suppressed intermediate-weighted and sagittal T2-weighted images show the popliteofibular ligament (arrows) which attaches to the myotendinous junction of popliteus tendon (arrowheads). C. Sagittal fat-suppressed intermediate-weighted image shows the anteroinferior (arrow) and the posterosuperior (arrowhead) popliteomeniscal fascicles which connect the posterior horn of the lateral meniscus, the popliteus tendon, and the joint capsule.
Fig. 4.
Arcuate and fabellofibular ligament. A, B. Sagittal T2-weighted and axial fat suppressed intermediate weighted images show the lateral limb of arcuate ligament (arrows) and fabellofibular ligament (arrowheads). The inferior lateral genicular vessels (open arrows) pass between the arcuate ligament and the fabellofibular ligament (arrowheads). C. Coronal fat-suppressed intermediate-weighted image shows the fabellofibular ligament (arrowheads) which originates from the fabella and inserts onto the fibular styloid process immediately lateral to the popliteofibular ligament.
Fig. 5.
Anterolateral ligament. A, B. Coronal and axial proton density weighted images demonstrate the capsulo-osseous layer of iliotibial band, also known as the anterolateral ligament (arrows), which courses lateral to the inferior lateral genicular vessel (open arrows) and finally inserts on the anterolateral tibial rim. The iliotibial band (arrowheads) courses anterior to the caspulo-osseous layer at the level of the joint and has a more anterior insertion on Gerdy's tubercle.
Fig. 6.
Anterolateral ligament complex. A. Coronal proton density weighted image shows the epicondylar band (arrows) anchoring the iliotibial band (arrowheads) to the femur. B. Sagittal T2-weighted image demonstrates the proximal Kaplan fiber (arrows) of the iliotibial band attached to the linear aspera of the femoral shaft. C. Illustration depicting the anterolateral ligament complex. Sagittal diagram shows the ITB, the EB, the PB, the SGA, the IGA, the JC, the LCL, and the ALL. The epicondylar band and the proximal band of the ITB run from the ITB and insert on the lateral femoral condyle and the linear aspera, respectively. The ALL originates near the origin of the LCL. It passes above the inferior lateral genicular artery, connects to the joint capsule, and inserts on the tibia. ALL = anterolateral ligament, EB = epicondylar band, IGA = inferior lateral genicular artery, ITB = iliotibial band, JC = joint capsule, LCL = lateral collateral ligament, PB = proximal band of ITB, SGA = superior lateral genicular artery
Fig. 7.
Schematic diagram of a cross section through the SSP and the ISP tendons, parallel to the surface of the glenoid. Layer 1 is the most superficial, composed of fibers of the CHL extend-ing from the coracoid process to the greater tuberosity and overlies the cuff tendons. Layer 2 is composed of packed parallel tendon fibers ex-tending from the muscle belly of SSP and ISP to the humerus. Layer 3 has a tendinous structure with smaller fascicles compared to layer 2. The fibers of SSP in layer 3 are intermingled with fibers from the adjacent subscapularis and the ISP. Layer 4 is composed of loose connec-tive tissue having thick bands of collagen. Layer 5 is the deepest of all and forms the true joint capsule of the shoulder. CHL = coracohumeral ligament, ISP = infraspinatus, LHB = long head of biceps tendon, SSP = supraspinatus
Fig. 8.
Angled arthroscopic view of the humeral footprint of the supraspinatus shows the RC (arrows) and the Cr. Long head of the ‘B’ slides through the bicipital groove behind humeral ‘H.’
B = biceps tendon, Cr = crescent, H = head, RC = rotator cable
Fig. 9.
“Suspension bridge model”. Osseous attachment of the rotator cable is analogous to the pillars of a suspension bridge, and the rotator cable is analogous to the cable connecting the pillars. The tension generated by the rotator cuff tendon medial to the cable is transferred to the osseous attachment, thereby preserving the function of the tendon as well as limiting the progression of a tear (Reference 31).
Fig. 10.
Rotator cable. A. Oblique coronal T2-weighted image demonstrates the prominent rotator cable (arrows) on the articular side of the supraspinatus tendon, also referred to as the “cable-dominant rotator cuff.” B. Oblique coronal T2-weighted image demonstrates the superior capsule (arrows) on the articular side of the supraspinatus tendon devoid of a cable-like structure.
Fig. 11.
Superior capsule of shoulder. A. Oblique coronal T2-weighted MR arthrography shows the superior capsule (arrows) and its footprint (arrowhead) on the greater tuberosity. B. Oblique sagittal T2-weighted MR arthrography shows the superior capsule (arrows) in continuum with the coracohumeral ligament (arrowhead).
Fig. 12.
Supraspinatus tendon slip. A. Axial T2-weighted MR arthrography shows the supraspinatus tendon slip (arrow) in the bicipital groove lateral to the long head of the biceps tendon (arrowhead). B. Oblique sagittal T2-weighted MR arthrography shows the course of the supraspinatus tendon slip (arrows) which originates from anterior margin of the supraspinatus and attaches to the humerus adjacent to the pectoralis major tendon.
Fig. 13.
Anteroinferior tibiofibular ligament. A. Consecutive axial T2-weighted images show obliquely oriented anteroinferior tibiofibular ligament (arrows) with origin at the tibia (left) and a fibular insertion (right). B. Oblique coronal reformatted three-dimensional fast spin-echo T2-weighted image shows the entire course of the anteroinferior fibular ligament (arrows) which is composed of multiple bundles. The inferior most bundle is the Basset's ligament (arrowheads).
Fig. 14.
Posteroinferior tibiofibular ligament complex. A. PITFL complex. The wide sPITFL originates from the posterior tubercle of the tibia and inserts on the posterior tubercle of the fibula. The dPITFL originates immediately inferior to the sPITFL and inserts on the posterior tubercle, deeper to the sPTIFL. The IML connects the inner surface of the medial malleolus and the lateral malleolus where the PTFL originates. B. Coronal fat-suppressed three-dimensional fast-spin echo sequence demonstrates the superficial PITFL (arrows), the dPITFL (open arrow), and the IML (arrowhead). C. Sagittal fat-suppressed intermediate-weighted image demonstrates the dPITFL (open arrow) which ap-pears like a “labrum” of the tibial rim, and the IML (arrowhead) which restricts the expansion of the posterior recess of the ankle. D. Axial T2-weighted images demonstrate the sPITFL (arrows) that originates from the posterior tubercle of tibia and inserts into posterior tubercle of fibula. The dPITFL (arrowhead) inserts deeper than the sPITFL into the posterior tubercle of the fibula. dPITFL = deep PITFL, IML = intermalleolar ligament, PITFL = posterior inferior tibiofibular ligament, PTFL = posterior talofibular ligament, sPITFL = superficial PITFL
Fig. 15.
Interosseous membrane and interosseous ligament. A. Axial T2-weighted image shows the interosseous membrane (arrowhead) that connects the lateral margin of the tibia and the medial margin of the fibula. B, C. Coronal fat-suppressed T2-weighted and axial T2-weighted images show obliquely oriented interosseous ligament (arrows) composed of proximal and distal bands.
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